A descriptive, longitudinal, prospective study of job-related psychosocial risk factors associated with the onset and progression of adverse secondary traumatic stress health outcomes in professional fire fighters and paramedics is proposed. This research proposal builds upon a prior large-scale cross-sectional survey of occupational stressors and stress- related symptomatology in Washington state fire fighters and paramedics. Fire fighter and paramedic exposure to occupational trauma is frequent and repetitive but little is known about the cumulative impact of such exposures on the health of these emergency workers. Also, very little is known about how pre-existing moderator and mediating variables such as cognitive coping strategies might buffer or exacerbate exposures to duty- related traumata over time and how other occupational stressors might interact with trauma exposure. Specifically, this research investigation proposes to study a sample of urban fire fighters and paramedics over a period of three years. An extensive survey battery will be used to measure pre-existing moderating variables, most psychosocial risk variables, mediating factors and adverse health outcomes. An independent and more objective measure of exposure to duty-related trauma will be obtained by linking fire department records of incident reports (both medical and fire suppression) with fire fighter/paramedic respondent survey replies at Time O and at 6-month follow-ups for 3 years. These data will be used to document baseline prevalences and incidences of post-traumatic, other stress-related symptomatology as well as alcohol use in an urban sample of fire fighters/paramedics. Using department incident records and survey data, the empirical interrelationship(s) across time between traumatic incident exposures, non-traumatic occupational and non-work stressors and adverse health outcomes indices will also be determined. Finally, these data will be used to identify pre-existing and moderating variables that influence the impact of duty-related trauma exposures, other occupational stress and specified health outcomes in urban fire fighters across time. These data will illuminate the natural history of post-trauma symptomatology, alcohol use and other stress-related symptoms in terms of their relationship(s) to the long-term cumulative exposure to job-related trauma as well as to other predictor, moderating and mediating variables. The findings will assist in the development of preventive and remedial interventions for fire fighters and serve as a model for parallel endeavors with other high strain occupations.